Provider Demographics
NPI:1447336441
Name:WILEY, ROBIN LYNN (LPCC)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:LYNN
Last Name:WILEY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22267
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502
Mailing Address - Country:US
Mailing Address - Phone:505-920-6554
Mailing Address - Fax:505-473-1297
Practice Address - Street 1:3012 CIELO CT STE C
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-5088
Practice Address - Country:US
Practice Address - Phone:505-920-6554
Practice Address - Fax:505-473-1297
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0070961101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03871347Medicaid
NMNM100416OtherVALUEOPTIONS